7.1 COMMUNITY ENGAGEMENT The Center is very pleased with its ability to demonstrate a productive working relationship between the community and Center researchers. This relationship arises from the interaction between the Center's established Community Based Participatory Research (CBPR), the Community Advisory Board, the Community Outreach and Translation Core, the Administrative Core, and our new relationship with Pediatric Health Specialist/Faculty Development Investigator Dr. Catherine Karr who will play a front and center role engaging the clinical community and mentoring fellows. Figure 7.1 below illustrates the network of relationships that make our community engagement efforts so fruitful. This network includes community stakeholders, university partners, health professionals, and policy makers, among others. For example, our collaboration with the Northwest Pediatric Environmental Health Specialty Unit (PEHSU), directed by Dr. Karr, allows us to translate lessons learned directly to clinicians. Likewise, our collaboration with the Pacific Northwest Center for the National Children's Study, directed by Center PI Dr. Elaine M. Faustman, allows us to coordinate efforts with neighborhood and community advisory boards to educate stakeholders about children's environmental health and pesticide exposure. 7.1.1 Role of the Community Based Participatory Research Project and Community Advisory Board For the last 10 years, the Center has been working with CBPR investigators from the Fred Hutchinson Cancer Research Center and with community organizations in the Yakima Valley to involve the community in research, interventions, and training. Only by combining work in the lab, in the field, and in the community \s the Center able to promote dialogue in multiple directions and bring a unique and successful approach to reducing the adverse effects of environmental pesticide exposures in children The Center is very proud of its outreach and translation efforts related to the community intervention project and cohort study conducted by the CPBR investigators. These investigators use a CBPR approach to engage the community in participating in issues related to pesticides. The community intervention project took place during the first phase of the Center in the Yakima Valley to educate families about pesticide protective practices. Intervention activities were targeted to ail community sectors and included information dissemination at health fairs, annual school calendar contests, home health parties, distribution of "Keep me Pesticide-free" bibs to newborns, soap kits for washing clothes separately, and many more activities. In total, the intervention team conducted 1,529 separate activities that reached 14,998 people. The cohort study took place during the second phase of the study and assessed multiple pathways of exposure to children of agricultural workers compared to children of non-agricultural workers. The CBPR work, in conjunction with the Community Advisory Board (CAB), has demonstrated that the Center structure has strengthened the scientific design of Center studies as a result of community and stakeholder interactions. The CAB is made up of representatives of all the constituencies involved in pesticides. For the past 10 years. The CBPR investigators have worked with the CAB in the Lower Yakima Valley of Washington State to reduce pesticide exposure among children of Hispanic farmworkers. In response to their work in the first phase of the Center conducting a community intervention study, the CAB encouraged the CBPR investigators to examine exposure to children of agricultural workers compared to children of non-agricultural workers. Specifically, the CAB wanted to know if farmworkers and their children had higher levels of organophosphate (OP) pesticide exposure than those of non-farmworkers and their children. In addition, the CAB wanted to examine multiple pathways of exposure, including the take-home pathway, a dietary pathway, an environmental pathway, and a lifestyle pathway. Finally, they wished to look at warehouse workers and their children for exposure to OPs. To do this, the CPBR investigators jointly designed, with the CAB, a cohort study that was conducted over the second phase of the Center in the Lower Yakima Valley. This type of interaction and input is unique to large Center funding mechanisms. For these reasons, this has been a wonderful opportunity to impact the whole continuum of children's health issues and to make a difference in the communities we engage! Based on further recent input from the CAB, the CPBR investigators are now proposing to re-contact previous study participants, both farmworker and non-farmworker households, to collect additional biomarker samples for analysis. The CBPR investigators consider the CAB to be an equal partner in the running of the project and gave them much decision-making authority, including the hiring of staff, input into the research design, input into all questionnaires and data collection procedures, budget decisions, intervention decisions, and placement on the External Advisory Committee for the Center. 7.1.2 Collaboration with the Community Outreach and Translation Core (COTC) The Community Outreach and Translation Core (COTC) is poised to leverage the cumulative impacts of the Center's efforts to date to engage communities. The COTC will build off the many successes of the COTC to date, and also launch additional efforts to collect, integrate and disseminate research findings and pursue exciting new means of enhancing outreach and translation efforts across Center projects and cores. The COTC, established a decade ago, is positioned within the Center to overcome barriers involved in sharing, interpreting, translating, and documenting data and information in an interdisciplinary and true collaborative research setting. The COTC is the Center's means of developing, implementing and evaluating strategies to translate and apply the scientific findings of the Center into information for the public, policy makers, clinical and public health professionals, and mothers and fathers to use to protect the health of children. The COTC has been very successful accomplishing a variety of goals and objectives catalyzing the growth of institutional and community capacity to disseminate results relevant to children's environmental health. Activities include fostering and forging critical partnerships at the University of Washington to carry out our aims;offering a graduate course and journal clubs relevant to child environmental health;and experience educating pediatricians and other health professionals. Other highlighted activities include publishing in peer . reviewed journals and presenting results at scientific meetings;international community outreach and translation;considering translating research across multiple contexts;and close collaboration with the Administrative Core. For the last 10 years, the COTC and Administrative Core have worked in close collaboration. Examples include coordinating journal clubs sessions highlighting child health research, maintaining the Center's Web site, preparing the annual report, and developing outreach materials such as case studies and flyers. Proposed new activities to be coordinated between the COTC and the Administrative Core include implementing a pilot project program with the Biomarkers and Exposure Assessment Core, create an e-mail listserv to facilitate communication among Center investigators, host periodic internal Center meetings to share results and brainstorm, developing a biannual newsletter to communicate our research with a broader audience of stakeholders, policy makers, and other interested members of the public. The COTC is particularly excited to partner with the Pacific Northwest Center for the National Children's Study (PNW-NCS) to engage communities and educate stakeholders, clinicians, and policy makers by participating together in outreach activities. As part of its coordinated effort to go into these communities, the PNW-NCS has identified over 300 community organizations and government agencies that interact with communities to engage. In addition, we have previously identified at least 30 programs at the University of Washington relevant to the study of children's environmental health. PNW-NCS Community Outreach Manager Ms. Lisa Younglove is a former Center outreach specialist herself. Activities can include participating in and sharing outreach materials developed for community festivals, neighborhood events, school events, and health fairs such as the South King County Latino Family Health Fair and the Latina Health Fair. Drs. Faustman, [unreadable] Burbacher, and Karr and Ms. Younglove currently work with the Collaborative on Health and the Environment - Washington, a diverse partnership of individuals and organizations working collectively to advance knowledge and effective action to address growing concerns about the links between human health and environmental factors. Ms. Younglove also participates in the CHE-WA working group organizing the Northwest Children's Environmental Health Forum, a 2-day event relevant to both PNW-NCS's mission and our Center's mission. Drs. Faustman and Thompson will present at the forum and share results from our Center's dust studies in the Yakima Valley assessing pesticide exposure. In addition, Ms. Younglove and Ms. Scherer are working together to help revive a Community Fair event that had been planned as the third day of the CHE health forum and was cancelled due to budget restraints. However, the PNW-NCS and our Center's COTC are looking at ways to pool resources to help ensure the Community Fair is not a lost opportunity as it provides an excellent opportunity to connect with community members around environmental health issues. 7.1.3 The Pediatric Health Specialist's Role in Engaging the Clinical Community and Mentoring A particularly exciting element of community engagement is the opportunity to work with the Center's Pediatric Health Specialist Dr. Catherine Karr who will bring her clinical translation and needs assessment skills to bear on this important topic of pesticide exposure and child health. Dr. Karr also serves as the Faculty Development Investigator and member of the COTC and Administrative Core, meaning opportunities abound for linkages across Center activities will translate to an enhanced ability to carry out the goals associated with engaging the clinical community and mentoring. Dr. Karr has experience training health care providers about pesticide risks to children, developing curriculum on environmental health topics, mentoring junior researchers and students, and developing and delivering specific health endpoint outreach on asthma and asthma triggers. In addition. Dr. Karr develops didactic sessions on environmental health issues for pediatric residency curriculum at the University of Washington. Dr. Karr also mentors Center Mentored Fellow Dr. Sheela Sathyanarayana, who works at the Northwest Pediatric Environmental Health Unit (PEHSU) directed by Dr. Karr. In partnership with Dr. Karr, the Center plans to co-hosted a two-part series of one-day CE courses entitled: 1) "Pediatric Environmental Health: Challenges and Opportunities in Pesticide Exposure and Asthma Risk Research," 2) "Pediatric Environmental Health: Translating Lessons Learned from the National Children's Study." Drs. Karr will also help to create and instruct a journal club entitled "Current Issues in Children's Issues in Environmental Health" that will be available to graduate students in disciplines not limited to environmental health, toxicology, heath services, medicine, genomics, and communication. The course will be available as a credit option and will offer a combination of discussing and presenting new journal articles relevant to children's environmental health, providing Center research updates, and offering NCS updates. NW PEHSU is poised to fulfill this mission through integrating our interdisciplinary team representing experts in industrial hygiene, environmental pediatric medicine, clinical toxicology, developmental toxicology, and occupational medicine along with well-established ties outside the academic arena. These include ongoing dialogue with key regional public health systems and research program leaders (e.g. Karen Larson, ATSDR Region X; Margo Young, EPA Region X Office of Children's Health;David Kalman, Chair UW Department of Environmental &Occupational Health Sciences;Bruder Stapleton, Chair, UW Pediatrics;Elaine Faustman, PI NIEHS Center for Children's Health and Environment;and Wayne Clifford, Site Assessment Manager of the EH Assessments Division, Washington Department of Health). These relationships and collaborations facilitate NW PEHSU activities within and without the academic arena. Within academia, PEHSU is committed to ensuring a pipeline of trainees equipped to address pediatric EH. These trainees will have opportunities for mentoring from Center investigators. In the community, NW PEHSU offers health professional training opportunities in multiple formats and locations to enhance our reach, including special efforts aimed at providers of underserved and particularly vulnerable populations (farmworkers, urban poor). The Center with collaborate with PEHSU most particularly in this regard. Importantly, PEHSU is available through a 24/7 toll free telephone line, email, and personal contact for health professionals seeking assistance in clinical problem solving, public health decision making, and risk communication regarding child health and environmental toxicant exposure. Nationally and regionally, PEHSU's goal is to reach and be responsive to health care professionals. NW PEHSU's rapidly rising number of consultation requests is a testament to our success in this realm.